Medications for bipolar and mood swings

Medications are an essential part of the plan when it comes to bipolar disorder. The right treatment can make a world of a difference. But figuring out which one is the right one can be challenging. Here’s a little information about mood-stabilizing medications to help you along.

What are mood stabilizers used for?

Mood stabilizers are prescribed to help stabilize mood (counter the highs and lows, or mania and depression) or decrease mood swings in patients with bipolar disorder. They also help fight against bad depression or mood swings in people without bipolar disorder and can treat impulsivity, agitation, or rage in a variety of disorders, including personality disorders, Schizophrenia, traumatic brain injury, autism, and dementia. Some mood stabilizers are used for physical problems like epilepsy, pain, or restless leg syndrome.

How do doctors choose which medication to prescribe?

Psychiatrists use mood stabilizers to help people with extreme mood states, but not all medications help all mood states. Some help with mania, whereas others help with depression. Some medications are better for euphoric mania. Others are better for rapid cycling or psychotic mania. Talk to your doctor about which is right for you. Often medications need to be prescribed in combination. Once you’re stable, your doctor might continue your current medication regimen over the long run, something called maintenance therapy. Some medications are indicated for maintenance therapy.

What medications are available for bipolar disorder?

Read on for a list of mood-stabilizing agents and selected side effects. This list isn’t exhaustive.

Lithium (Eskalith, Lithobid).Lithium is good for mania and depression. It’s best for euphoric mania. Lithium is a naturally-occurring element, a single atom, and is the only mood stabilizer proven to lower suicide risk. Possible side effects include shaking, upset stomach, excessive thirst and urination, acne, hair loss, slight weight gain, fuzzy thinking, thyroid problems, rashes, and (rarely) confused thinking or delirium, kidney disease, or heart problems. Lithium shouldn’t be taken in pregnancy.

Valproic Acid, or VPA (Depakote, Depakene).VPA is better for mania than depression; it’s especially good for agitated mania and for people whose mood swings go up and down quickly (rapid cycling). Some people complain of shakiness, weight gain, sleepiness, upset stomach, and (rarely) low platelet count, pancreatic disease, and liver problems when taking this medication. VPA shouldn’t be taken during pregnancy.

Carbamazepine (Tegretol).Carbamazepine is good for mania, including agitated manias and rapid cyclers, but it isn’t used frequently these days due to its multiple drug interactions. Possible adverse effects include dizziness, blurred vision, weakness, upset stomach, mental slowing, and (rarely) “salt” or electrolyte abnormalities, life-threatening rash, bone marrow suppression, liver problems, and heart disease. Carbamazepine shouldn’t be taken during pregnancy.

Oxcarbazepine (Trileptal). This medication is like Carbamazepine, but with fewer medication interactions and (similar but less intense) side effects. It is better for mania than depression and particularly good at helping people with agitated manias. Oxcarbazepine shouldn’t be used in pregnancy.

Topiramate (Topamax).Topiramate is better for mania than depression. This medication is popular because it can cause weight loss. People who take it sometimes complain of sleepiness, decreased concentration, slowed thinking, tingling sensations in the extremities, and “salt” or electrolyte abnormalities. In rare cases it can cause kidney stones. There aren’t a lot of studies using Topamax in pregnancy.

Lamotrigine (Lamictal).This medication is better for depression than mania, and it’s also indicated for maintenance therapy. Possible adverse effects include dizziness, headache, blurred vision, decreased coordination, sleepiness, benign rashes, and (rarely) a life-threatening rash. To avoid a serious rash, Lamictal is started at a low dose and increased very slowly. Don’t stop all at once. There aren’t a lot of studies using this drug in pregnancy. Lamictal isn’t used in kids.

Atypical Antipsychotics.Although they are used for hallucinations and delusions (symptoms of psychosis), these drugs are very helpful for people with mood swings, as they have both anti-manic and anti-depressive effects. They’re particularly beneficial for individuals with psychotic depression or psychotic mania. This group includes meds like Quetiapine (Seroquel), Risperidone (Risperdal), Olanzapine (Zyprexa), Lurisadone (Latuda), Aripiprazole (Abilify), plus many others. Olanzapine (in combination with Prozac), Lurisidone, and Quetiapine are indicated for bipolar depression. Almost all atypical antipsychotics are used for mania. Adverse effects vary from medication to medication, but in general they include sleepiness, weight gain, dizziness, high blood sugar, high cholesterol, seizures, and movement disorders, as well as (rarely) heart conduction changes, coma, and sudden death in the elderly. Some antipsychotics have more side effects than others. These medications tend to be safer in pregnancy, but there aren’t many studies.

First Generation Antipsychotics (FGA). The FGA’s have been around a lot longer than the atypical antipsychotics and include meds like Haloperidol (Haldol) and Chlorpromazine (Thorazine). They have anti-manic properties but don’t help with depression. The FGA’s are particularly good for individuals with psychotic mania and are typically used in combination with other mood stabilizers. People who take Haloperidol occasionally complain of slight sleepiness, sexual side effects, movement disorders, and (rarely) heart conduction changes. Chlorpromazine is associated with sleepiness, dry mouth, blurred vision, problems urinating, confused thinking, dizziness, falls, shuffling gait, and (rarely) heart conduction changes, bone marrow suppression, and liver disease. Both can (rarely) cause coma. Some FGA’s are used frequently in pregnancy.

Benzodiazepines (benzo’s).The benzo’s include meds like Lorazepam (Ativan), Clonazepam (Klonopin), and Alprazolam (Xanax). Benzo’s do have some mood stabilizing effect, albeit not as much as the other mood stabilizers listed above. They aren’t used frequently for this purpose because of their addicting nature. Use of a benzo for more than three weeks is often associated with tolerance to its effect — and withdrawal if stopped abruptly. People who take one benzo’s sometimes complain of sleepiness, dizziness, mental slowing, poor coordination, and (rarely) breathing problems and coma. This group of meds is not safe in pregnancy.

What about antidepressants for depression?

While psychiatrists do prescribe antidepressants for depression in individuals with bipolar disorder, studies show that antidepressants often don’t work and, in the rare case, can make things worse. They can exacerbate the depression, trigger a mania, or cause heightened mood swings. On the other hand, there is a subset of people with bipolar disorder who benefit from taking antidepressants along with their mood stabilizers.

What mood-stabilizer is right for me?

It can be frustrating looking for the right medication. You might need multiple trials of different mood-stabilizers, and it’s likely you’ll need a combination. The trick is to not give up. Eventually your psychiatrist will find a prescription that’s right for you.

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6 thoughts on “Medications for bipolar and mood swings”

Lithium & the monoamine oxidase inhibitor Parnate (tranylcypromine) has been the only med. combo. that has ever worked to lift my treatment-resistant bipolar depression. (I had tried 25+ meds since being diagnosed with bipolar, peripartum onset in 2007.) The food & alcohol restrictions are absolutely worth the miracle of no longer suffering from severe depression.

I wrote about these medications in my book “Birth of a New Brain – Healing from Postpartum Bipolar Disorder” (Post Hill Press) with a foreword by perinatal psychiatrist Dr. Carol Henshaw. I was honored my book was endorsed by Kay Redfield Jamison and other mental health luminaries.

Hello Dyane: It sounds like you’ve had a painful journey, but I’m glad you’ve found a combination of medications that helps. The MAOI’s can be a godsend!

I don’t think people realize how difficult it is to get bipolar depression under control, nor how devastating it can be; it’s far more challenging to treat than nonbipolar (unipolar) depression. Luckily new treatments are emerging everyday, like transcranial magnetic stimulation and ketamine infusions.

Congratulations on your book. And an endorsement by Kay Redfield Jamison… that’s wonderful! I’m sorry your bipolar disorder had to surface in such a difficult way, but your story in print will remind many people they’re not alone. Good luck, and take care.

Thank you for mentioning the possibility of mania with antidepressants. SSRI’s induce mania for me, I can’t take them. Abilify is what has helped my depression immensely. I think some people are reluctant to take antipsychotics just because of the perceived stigma of the word “psychotic”.

I’m glad you found a medication that helps you. You’re right about antipsychotics. People are afraid to take them. It’s a shame, since they can work wonders for depression, as well as for mood swings, mania, paranoia/psychosis, aggression, impulsivity, autism, Tourette’s, insomnia, anxiety, intractable hiccoughs/nausea, and that’s just part of the list. The problem (and I’m sure you know this) are the side effects. Few people develop all the side effects the pharm companies list in their pamphlets, and each antipsychotic is different, but that list still scares people. On the other hand, I’ve seen these meds save lives!